Application for Employment

First Name:
Middle:
Last:
Social Security No:
 
Present Street Address:
City:
State:

Zip Code:

 
Telephone #:
Are you 18 Years or older? Yes

No
email:


Height:
ft in 		Weight:
 Date of Birth:
  

Have you ever been convicted or pled guilty or no contest to, a felony offense? If so, please explain**. [For purposes of employment with Dynacon, Inc. “conviction” includes sentenced to confinement, time served, probation (including deferred adjudication) and court-ordered restitution.]

Yes No


If YES, describe:

* The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but not less than 70 years of age.

**You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.


Position:
 date you can start:
 Desired Salary:
Are you employed now? Yes No


 If yes, may we inquire of your present employer? Yes No  
Give any additional information on skills or past job responsibilities:


Education
Name and Location of School
Years Attended
Year Graduated
Subjects Studied
High School
 to
College
 to
Trade, Business or Correspondence School
 to

US Military or Naval Service: Rank: Present Membership in National Gaurd or Reserves:


Dates (dd/mm/yy)
Employer's Name and Address
Start:

End:

Employer:

Address:
Position Held:

Reason for Leaving:

Salary:
Start:

End:

Employer:

Address:
Position Held:

Reason for Leaving:

Salary:
Start:

End:

Employer:

Address:
Position Held:

Reason for Leaving:

Salary:


Name Phone Business Years of Acquaintance


Do you have any physical limitations that preclude you from performing any work for which you are being considered?
Yes No
 
*If YES, describe:
**In case of emergency notify:
Name:
 Relationship:
 Phone:
  


“I UNDERSTAND THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY THAT MAY RESULT FROM FURNISHING SAME TO YOU.

I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE.

I ALSO AGREE TO IMMEDIATELY NOTIFY THE HUMAN RESOURCE MANAGER OF DYNACON, INC. IF I AM CONVICTED OF, OR OTHERWISE PLEAD GUILTY OR NO CONTEST TO A FELONY, OR ANY CRIME INVOLVING DISHONESTY OR A BREACH OF TRUST, WHILE MY APPLICATION IS PENDING OR DURING MY PERIOD OF EMPLOYMENT.”